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The overall goal of the current research was to estimate allowable post-operative weight-bearing with four MTP fusion techniques with the purpose of providing sound reasoning for post-operative weight-bearing recommendations. A minimum estimate of the hallux load for a 784 N patient, the average body weight for a male, would thus lead to 196 N of load beneath the first MTP joint, which any MTP fusion construct would have to support. The subhallucal load can be 25% of body weight at toe off during normal gait, and, although touch-down weight-bearing and the use of assistive devices could reduce this demand, a large upper limit on the allowable load would ensure greater confidence in the outcome. Studies have suggested immediate weight-bearing may be acceptable and is preferable, though the extent of allowable weight-bearing is unknown. Patients are expected to mitigate the impact of any gait loading on the great toe. Post-surgery protocol includes either non-weight-bearing or weight-bearing in a postoperative shoe to avoid high pressure under the metatarsophalangeal (MTP) joint. Late stage hallux valgus and hallux rigidus are commonly treated in osteoarthritic patients with arthrodesis using mechanical hardware to stabilize the joint.
#Mtp fusion plus#
The plate plus screw offered the greatest stiffness the failure test showed that no construct could withstand weight-bearing as tolerated and, synthetic composite models of the MTP joint did not provide the consistent results in stiffness and failure. The plate plus screws were statistically more stiff than crossed screws ( p = 0.008), but there was no statistical difference between synthetic and cadaveric bone in load to failure ( p = 0.296). Loads to failure of the unlocked plate plus screw and crossed screws in synthetic bone were 131 and 101 N, respectively and in cadaveric bone were 154 and 94 N, respectively, which are less than the estimated 25% body weight required at the MTP joint. The unlocked plate plus screw and crossed screw constructs were stiffest ( p < 0.008). Stiffness and load to failure testing for the two more rigid constructs in paired cadaveric bones were followed. Stiffness was calculated and then used to find the two most rigid constructs the load to failure was recorded. Methodsįour MTP fusion modalities were tested in synthetic composite bone models: unlocked plating, locked plating, crossed lag screws, and an unlocked plate with a single lag screw. A comparison of synthetic composite to actual bone was included in order to examine the validity of the testing conditions. This study sought to determine whether several metatarsophalangeal (MTP) fusion techniques require complete immobilization or if some level of weight-bearing could be recommended after surgery.